Complete mesocolic excision and extended lymphadenectomy: Where should we stand?

Debate regarding the risks and merits of complete mesocolic excision and extended lymphadenectomy is ongoing, particularly for right-sided colon cancers. In this article, we hope to provide a succinct yet encompassing review of the relevant literature. We posit that complete mesocolic excision with D3 dissection is indicated in select patients with colon cancers, particularly those distal to the cecum.

MACULAR DEGENERATION AND ASPIRIN USE.

PURPOSE: To review current literature of the benefits that aspirin provides for patients' cardiovascular health compared with the risk of AMD worsening. METHODS: We performed a review and critically analyzed six cardiovascular and four ophthalmological trials regarding risks and benefits of aspirin use. The prospective randomized cardiovascular trials had a cumulative 167,580 while the 3 smaller ophthalmological data sets had a cumulative 12,015 subjects. RESULTS: The reviewed meta-analysis literature demonstrated a statistically significant 32% reduction in the risk of nonfatal stroke with regular aspirin users. The study also documented that aspirin users decreased the risk of fatal vascular deaths by 15%. Of the three ophthalmological studies highlighting the adverse affects of aspirin association with AMD, all suggested an exacerbation of AMD without statistical significance and broad confidence bands. CONCLUSION: Overall, the number, size, and quality of the cardiovascular studies recommending aspirin use are far superior to the fewer, smaller and conflicting studies suggesting a possible adverse effect of aspirin use in relation to AMD. The benefits of aspirin usage include preserving the duration and quality of life by decreasing stroke and heart attack risk. These benefits seem to far outweigh the theoretical risks of possibly exacerbating wet AMD, which can be reasonably controlled with anti-VEGF therapy.

The Delayed Diagnosis of a Submassive Pulmonary Embolism Following Influenza A Infection Treated With Half-Dose Tenecteplase: A Case Report.

The coronavirus 2019 (COVID-19) pandemic has brought renewed attention to thrombotic complications arising from respiratory viral infections, driven by inflammatory responses and activation of the coagulation cascade. While influenza typically resolves on its own, information about its thromboembolic risks remains limited. The persistence of symptoms and the similarity between influenza symptoms and those of pulmonary embolism (PE) often lead to diagnostic delays, which can significantly impact patient outcomes. We discuss a case of a 62-year-old woman with a history of hypertension and hyperlipidemia who presented with dyspnea, syncope, and persistent symptoms following influenza A infection. Despite initial treatment with Tamiflu and subsequent antibiotics for presumed pneumonia, her condition worsened, leading to syncope and admission to the hospital. A diagnostic workup revealed saddle pulmonary emboli with right ventricular strain. She was treated with a half-dose of tenecteplase, resulting in significant clinical improvement and a notable reduction in thrombus burden on follow-up imaging. The thromboembolic complications of influenza A are not extensively documented compared to COVID-19, yet they can present with severe outcomes. Submassive PE, characterized by hemodynamic stability with signs of right ventricular strain, poses treatment challenges. While full-dose thrombolytics are generally avoided in intermediate-risk PE due to bleeding risks, half-dose thrombolytics such as tenecteplase can offer a safer alternative. Though not FDA-approved specifically for PE, tenecteplase has shown efficacy and was effectively used in this case. Half-dose thrombolytics, including tenecteplase, may be a viable treatment option for certain cases of PE, offering a balance between efficacy and safety. This case highlights the importance of considering PE in patients with persistent respiratory symptoms post-influenza and demonstrates the potential of tenecteplase in managing submassive PE.

Thromboembolism Triggered by a Combination of Electronic Cigarettes and Oral Contraceptives: A Case Report and Review of Literature.

Genetic predisposition, oral contraceptive (OCP) use, tobacco smoking, cancers, and trauma are well-known triggers for hypercoagulability and thromboembolism. Multiple reports have been published on the health risk of combining OCP and traditional cigarettes smoking in the context of thromboembolism. However, limited information is available on the health consequences of combining OCP use with electronic cigarettes. Here, we report a case of a young female patient with a past medical history of ovarian cysts and electronic cigarettes use who came into the hospital with a complaint of "recurrent seizures" and tachycardia. This patient was subsequently diagnosed with bilateral pulmonary emboli, subacute cerebrovascular accident (CVA), and possible patent foramen ovale. Therapeutic Lovenox was initiated. Reasons to educate young females on the risks of combining OCP and electronic cigarettes use were explained.

Fungal Endophthalmitis after Intravitreal Injections of Triamcinolone Contaminated by a Compounding Pharmacy: Five-Year Follow-up of 23 Patients.

PURPOSE: To report the 5-year outcome of an outbreak of Bipolaris hawaiiensis fungal endophthalmitis caused by contamination of intravitreal triamcinolone from Franck's Compounding Pharmacy in Ocala, Florida. DESIGN: Retrospective case series. PARTICIPANTS: Twenty-three patients (n = 25 eyes). METHODS: Data was collected from the practice of a single retina specialist in Los Angeles (K.W.S) and a retina practice in New York City. Intravitreal injections of triamcinolone obtained from a single lot were subsequently found to be contaminated with Bipolaris hawaiiensis. MAIN OUTCOME MEASURES: Visual acuity; presence of vitreous cells, anterior chamber cells, or both; and detection of fungi or fungal elements in samples obtained by vitreous needle aspiration or vitreous biopsy. RESULTS: Fungal endophthalmitis developed in 92% (23/25) of eyes. Despite aggressive local and systemic long-term therapy, severe visual loss resulted in the majority of treated eyes and the enucleated eyes showed evidence of hyphae. CONCLUSIONS: These reported cases of Bipolaris hawaiiensis endophthalmitis provide important messages for clinicians and regulatory agencies. First, patients treated with high-dose, long-term, orally administered voriconazole appeared to achieve better outcomes in treatment of Bipolaris endophthalmitis. Second, treated eyes may still show signs of deterioration, indicating the potential survival of causative organisms or fibrosis encapsulating the ciliary body, leading to hypotony. Third, several parallels can be drawn between this outbreak and the fungal meningitis outbreak after Exserohilum rostratum contamination of methylprednisolone by the New England Compounding Center.